*****Please do not take this class in the Teachable App*****
The Makous Protocol.“Shaking it Up” with New and Creative Internal Electrical Stimulation. A Unique and Effective Intra-vaginal and Intra-anal Physical Therapy Strengthening Protocol.It is an original protocol created by Elizabeth Makous, a Pelvic Floor Physical Therapist for over 26 years.
To my knowledge there is no other Internal Electrical Stimulation (IES) Protocol in the literature that uses the IES as I have used it and present herein.
The Makous Protocol is a method of Internal Electrical Stimulation that has helped thousands of patients respond faster to traditional pelvic health therapies as well as to heal bowel, bladder, and sexual dysfunctions of those who have not responded to traditional physical therapy or medical treatments!
Fellow clinicians please sign up for my course so I can take you on a journey that imparts to you the lessons I have learned, the knowledge I have gained and the evidence-based research available to understand the Makous Protocol. You too may help your most desperate patients heal with the Makous Protocol! I promise you it will be transformative to your clinical practice!
- Describe why a therapist should choose the Makous Protocol.
- Describe the Makous Protocol progression, compliance, and relapse.
- How I determined the parameters of the Makous Protocol.
- Describe traditional IES Protocols and Parameters based on literature and textbook reviews.
- Describe my theory of how traditional protocols and parameters were developed.
- Present Research Indicating the ineffectiveness of traditional IES Parameters.
- Bonus section: Describe my clinical approach to using Internal and External ES for pelvic as well as head and neck cancer patients.
- Describe the factors that facilitate the clinical effectiveness of the Makous Protocol.
- Describe how to determine which patient is appropriate for the Makous Protocol.
- Relative Contraindications and Contraindications to using the Makous Protocol.
- Describe therapist requirements:
- Ability to make an accurate physical therapy diagnosis
- Sound clinical reasoning skills
- Ability to be creative with wisdom
- Provide extensive clinical examples of the power of the Makous Protocol to be creative in meeting the needs of many patient populations.
- Summarize my theories of why the Makous Protocol works.
- Provide a video demonstration presenting details of how I educate my patients to use The Makous Protocol at home.
- Case Studies
Two cases will be presented to help the therapist understand the power of using the Makous Protocol to strengthen the entire pelvic floor vaginally or rectally.
One case study will be of an 84-year-old female with severe Grade 3 Cystocele (Stage IV based on POP-Q) causing urinary urge incontinence (UUI) and hesitancy with retention if she does not strain the get urine out.
The second will be of an 80-year-old male with severe urinary incontinence (UI), chronic urinary tract infections (UTIs), and erectile dysfunction (ED) caused by a Transurethral Resection of the Prostate (TURP) performed three years prior. The patient uses a penile clamp, condom catheter or adult diaper at all times. Other complicating factors include history of open heart surgery, hernia repair, and chronic pain and constipation due to Rheumatoid Arthritis
His current medications include methotrexate, prednisone, daily baby aspirin, vesicare, and hydrocodone.
I will describe in detail how my protocol is used in each case to resolve the patient’s symptoms.
In Case 1, the patient reported complete resolution of urinary symptoms and a 75% reduction in prolapse (Grade 1 or Stage II) after only 8 sessions of almost once a week therapy, and the Makous protocol of IES at home.
In Case 2, the patient reported total remission of urinary incontinence with only 2 to 3 drops of urine leakage a day, elimination of recurring UTIs, and regaining of erectile and ejaculatory function with ongoing use of anal IES using the Makous Protocol. This only required 11 treatment sessions and 11 weeks of the Makous Protocol with significant improvement after only 9 weeks.
- Need for Future Studies discussed.
- Peer Reviewed References. Posted at the end of the lessons in the Additional Comments section
I have been a Pelvic Health Therapist for over 26 years. My career has been focused on helping patients with very complicated bladder, bowel and sexual dysfunctions and pelvic pain. Along with the Pelvic Health specialty I have two certifications in edema and lymphedema management. Merging specialized treatment of the lymphatic system with the musculoskeletal system enhances treatment effectiveness and facilitates healing in patients with complicated issues. This is remarkably true when I treat cancer patients.
I have always enjoyed learning from and mentoring colleagues. My current positions is Coordinator of the Pelvic Health and Lymphedema Programs at Henry Mayo Hospital (Valencia, CA).
I have mentored in a more official capacity as a TA for Herman and Wallace Pelvic Rehabilitation Institute and Norton School of Lymphology.
I recently had the honor of going on a medical mission trip to Kenya where I was privileged to serve impoverished men and women with pelvic pain and dysfunction.
Elizabeth Makous MSPT, CLT, PRPC, CES
University of Florida - Bachelor of Science in Neurobiological Sciences
Masters of Exercise and Sports Sciences in Exercise Physiology
Bachelor of Science in Physical Therapy, 1992 (Highest Honors)
Certified Lymphedema Therapist (CLT)-
Norton School of Lymphology, 2012
Pelvic Rehabilitation Practitioner Certification (PRPC)-
Herman and Wallace Pelvic Rehabilitation Institute, 2014
Certified Edema Specialist (CES)-
North American Seminars, 2018
Certified Clinical Instructor (CCI)-
StartSection 1: Overview, Disclosures, Relevance, Objectives, Video 1 (Why choose the unique Makous Protocol), Makous Protocol ES Parameters, Video 2 (What does that mean?-understanding the parameters.) 19:08 min (19:07)
StartSection 1 Quiz
StartSection 2: Disclaimer, Liturature Review of Traditional IES, Cochran Review, History of PF IES max on and off times, NMES parameter research. 14:57 (14:57)
StartSection 2 Quiz
StartSection 3: Russian Stim, BMAC, current NMES protocols, Denervated (AC or DC) 5:10 (5:09)
StartSection 3 Quiz
StartSection 4: Book reviews, Cochran to Bergman, Makous Protocol, Current research (women and men), TvNMES, EES, why chose Makous Protocol. 9:40 (9:39)
StartSection 4 Quiz
StartSection 5: NMES for cancer patients( prostate, uterine, ovarian, bladder, breast, and externally for head and neck cancer. 8:57 (8:57)
StartSection 6: Factors leading to success of Makous Protocol , evidence for Makous Protocol, facts about the ES unit and IES probes and why it works. 35:5 (18:22)
StartSection 6 Quiz
StartSection 7: Background research -muscle physiology, electrophysiology. 6:14 (6:14)
StartSection 7 Quiz
StartSection 8: Determine which patients are appropriate for Makous Protocol, relative contraindication, contraindications. Video 6-Clinical Assessment skills. 20 (20:00)
StartSection 8 Quiz
StartSection 9: Creativity with the Makous Protocol using clinical scenarios . 13:03 (13:02)
StartSection 10: Fine tuning IES by modifying probe and body positions. 3:47 (3:46)
StartSection 10 Quiz
StartSection 11: Further IES clinical reasoning- standing vs lying, bedridden or wheelchair bound, probe "sweet spot", thin vs heavy patients, complete PFMS denervation, Theories of Makous Protocol effectiveness. 9:02 (9:02)
StartSection 11 Quiz
StartSection 12: video 7 (How I instruct patients), NMES Machine Parameter Settings Handout. 27:45 (22:45)
StartSection 13: Case study descriptions and outcomes. 2:01 (2:00)
StartSection 14: Clinical Case Study 1 (Severe Grade 3/ Stage IV by POP-Q Prolapse with UUI and Hesitancy). 13:46 (13:46)
StartSection 15: Case study 2 (TURP leading to Severe UI, Chronic UTI, Erectile Dysfunction). 14:21 (14:20)
StartSection 16: Limitations, Discussion, Summary Goals of the Makous Protocol, Future studies, Modifications to Market Products. 5:05 (5:04)
StartSection 17: Course Evaluation. 1+ min
StartSection 18: Thank You and Additional Course Info: References, acknowledgments. 2+ min
StartSection 19: Final Post Course Completion Test; Certificate; How to get on the Makous Protocol Certified Practitioner list; How to blog or write a class testimony. 8.23+ min
Frequently Asked Questions
Effective date of Registration: 4/28/2019